It can’t have escaped many people’s notice that English politicians continue steadily to throw the limelight on the performance of the Welsh NHS. With Wales the only UK administration managed by Labour, the Conservative party has consistently sought to highlight the state of the Welsh NHS, perhaps in response to Labor’s comparative political benefit on the NHS in the forthcoming UK election. Because of its part, the Labor party – both in Cardiff and Westminster – has frequently defended its record by claiming it is difficult to compare the NHS in England using its counterpart in Wales. Comparisons are difficult, but some can be produced.
Last of the Nuffield Trust and Health Foundation published a study taking the long view of NHS performance over the four countries using around 20 similar signals of performance, from patient satisfaction to ambulance response times. No one country lagged behind or outperformed another consistently, relative starting factors were taken into account once.
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A foreigner would be more struck by the similarities than the distinctions. However, England and Wales differ in lots of ways as countries, and since 1999 their two health services have been separately run. So it shouldn’t be very surprising that we now have some important differences. Wales doesn’t have the “purchaser-provider split” – the internal market, where elements of the English NHS buy services from other areas. Instead the Welsh NHS functions through integrated health planks. Unlike England, it makes very little use if the private sector.
However, our bottom line in the Four Countries report was that much as this type of structure is debated and centered on by experts and politicians, they have very little impact on relative performance. The Welsh people are old, sicker, and have more deprivation than the populace of England. All these factors influence people’s health and therefore mean greater needs on the Welsh health service. Any comparisons need to take this into account.
There is also an inherent unfairness in evaluating performance for a human population of three million with that for just one of 54 million. So evaluating Wales with an English region is likely to be fairer, while not straightforward, which is why we used the North East of England as a comparator in our report where possible. Its population characteristics are much nearer to those of the devolved countries than England all together. The devolved federal government in Wales has used its powers to create different priorities and a different tone from its London counterpart. It has emphasized avoidance and public health more than England.
Difficult decisions have been required since 2010 and the start of austerity. Different approaches have been used. England (and Scotland) have shielded NHS spending which has seen some small real terms growth during the last four years. Not so in Wales, where health spending has been cut in real conditions by 4.3% between 2009/10 and 2012/13, although there have now been further cash injections in 2014/15 and prepared for 2015/16 to invert this trend.
On the other hands, England has cut federal government grants to local authorities, producing a 16% reduction in funding for interpersonal care for the over 65s – an underlying cause of some anxiousness. In Wales, local authority spending has organized, although this is planned to change now. Wales has chosen to prioritize its spending differently within the medical sector, adopting policies like free prescriptions and car parking. The collective impact of different populations, policy choices, and investment decisions on recent performance are seen in the next graphs.